P1720: HOW TO IMPROVE THE TIME IN THERAPEUTIC RANGE (TTR) OF ANTICOAGULATED CHILDREN DURING THE COVID-19 PANDEMIC: TELECONTROL VERSUS TRADITIONAL HOSPITAL CONTROL
Authors: R. MARTOS MARTÍNEZ, L. BERMEJO MARTÍNEZ, D. CORNEJO CORRALES, M. YUSTE PLATERO, E. GONZALEZ ARIAS, P. BELTRÁN ALVAREZ, D. NAYA ERREA, E. HERREROS MONTERO, B. VILLA GONZÁLEZ, L. SASTRE MARTIN, P. LLAMAS SILLERO
Journal: HemaSphere (2022)

Background: The Covid-19 pandemic generated added difficulty in carrying out oral anticoagulation controls in children, due to limited travel to health centers for the mobility restrictions. Children there is greater difficulty in maintaining adequate coagulation times, measured in times in therapeutic range (TTR) due to the significant individual variability in anticoagulant medication that can cause thrombotic or hemorrhagic complications. We proposed carrying out controls at home telematically as an alternative to traditional hospital controls, avoiding travel during the pandemic and evaluating the safety of the results and the quality of life (QoL) Aims: To assess the efficacy of remote control in children with chronic oral anticoagulation compared to patients with hospital control based on the analysis of TTR during covid-19 pandemic as well as QoL Methods: Observational and longitudinal study comparing 2 cohorts: remote control group and hospital control group. During 2020, the patients were included in the remote control group in accordance with the usual clinical practice, keeping in hospital control those children who had to follow specific treatments in the hospital (cancer treatments). Classified the patients according INR ranges and age: 3 groups INR ranges established (1.8-2.2; 2.2-2.5 and 2.5-3) according to medical criteria and 3 age groups (0-6 yrs, 7-12 yrs, and 13-16 yrs). In January 2021, TTR data defined in both groups were collected according to Rosendaal’s methodology. Given the complexity of the TTR due to the pharmacokinetic variability of the antivitamin K drugs, which means that the specific determination in one day does not correspond to the INR values ​​that the patient will present on the days between the controls, we calculated the TTR of each patient by the fraction (number of INR in therapeutic range/total number of INR). We distributed patients into 4 groups: Group A: patients with less than 25% TTR. Group B: patients who have been between 25%-50% of TTR. Group C: patients who have been between 50%-75% of TTR. Group D:patients who have more 75% of TTR Results: 44 patients were included: 23 remotely controlled (mean age 8.4 yrs) vs. 21 hospitalized (mean age 9.1). Reasons for anticoagulation: surgery, catheters, cancer, heart disease and vasculitis. Controls outside the therapeutic range were on average higher in the hospital group (15.1 vs 3.3), maintaining these differences for all ages and INR ranges. 91% children in remote control spend more than 75% in TTR compared to 13% of the hospital group, being significant in children older than 7 years, with INR 2.2-2.5 and with catheters or heart disease. 5 children in the remote-control group with 100% of their determinations in TTR. 16 bleeding events were documented, 12 in hospital group(4 major bleedings)and 4 bleedings (all minor) in remote control. 15 thrombotic events (14 hospital control vs 1 in remote control). 81 doses of low molecular weight heparin (LMWH) and 31 doses of vitamin K (VK) were administered to hospital control children vs. 15 doses of LMWH and 6 vials VK to remote control children Summary/Conclusion: Remote control of anticoagulation in children is an effective and safe alternative to traditional hospital control, with very high TTR results. Using this type of control to avoid travel during mobility restrictions due to the covid-19 pandemic led to improved results, with fewer emergency visits related to anticoagulation, with a lower rate of bleeding or thrombotic complications, and less need for LMWH support. or VK compared with children with hospital control